Planning a Pregnancy? Prepare with Folate Rich Foods!

Planning a Pregnancy? Prepare with Folate Rich Foods!

Don’t just supplement your folic acid, increase it in your diet as well!
Screen shot 2013-03-24 at 9.18.24 PM
Folic acid is a water soluble vitamin that is absolutely essential to the early development of your baby.  Deficiency greatly increases the risk for congenital abnormalities, such as neural tube defects (abnormalities of the nervous system), a cleft palate, and more. Don’t forget that you need it, too! Many activities of normal life, such as enjoying an alcoholic beverage or taking an aspirin, can decrease your folic acid stores. Without this busy little vitamin, your cells would be unable to synthesize and maintain your DNA.

To properly plan for pregnancy (especially the first month), I recommend women take 400 micrograms of folic acid daily for 3 months prior to removing birth control. This is in addition to a high quality prenatal multivitamin that already offers at least 400-600 micrograms of folic acid, therefore giving you a total of at least 800 micrograms a day. Combined with the dietary suggestions below, this will replenish your folic acid stores and promote health in your unborn child.

Foods High in Folic Acid

Beef Liver
Please buy organic. Beef liver is also an exceptional source for iron, which can help to prevent anemia and fatigue during pregnancy. Speak with your doctor about how much liver is safe for you, as it also contains high levels of vitamin A and should be eaten in moderation for its rich nutrients.
Spinach
Like liver, spinach is also a great source for iron, as well as vitamins A and C.
Black-eyed peas
Rich in fiber and calcium, too!
Asparagus
A low calorie, vitamin and mineral rich source of fiber.
Avocado
These fruits pack a nutritious punch, thanks to their abundant good fats and fiber, you will feel full and satisfied.
Citrus Fruits
Aim for eating the whole fruit, not just the juice.
Brussel Sprouts  & Broccoli
Both of these green giants provide up to a quarter of the recommended daily intake for an average, healthy adult.
Nuts & Seeds
Sunflower seeds, flax and almonds are all high in folic acid, good fats, and fiber!

 

 

For additional information on folic acid, please visit the National Institutes of Health at: http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

Dr. Kaley Bourgeois

Understanding IUD’s

Understanding IUD’s

According to a 2012 study which sought to reveal how American woman view intrauterine devices for birth control, the majority of those surveyed had inaccurate information about the efficacy and health concerns associated with IUD’s. Areas of misinformation included:

Efficacy: Most women did not know that IUD’s are more effective than the pill
STD’s: Nearly half of the women did not know that IUD’s do not increase STD risk
Cost: Most women did not know IUD’s are more cost effective over time than the pill

In other developed countries, especially throughout Europe, IUD’s are a leading form of birth control. For comparison’s sake, consider the following: IUD’s were used by only 2% of U.S. women on contraception in 2002, whereas countries such as Norway reported usage rates of greater than 20%.

I cannot speak to why IUD’s lack popularity among American women, but I do believe this lack of popularity, in part, explains why so many of us have incorrect information. With less popularity comes less use, and therefore less exposure to information (both professionally and through the experience of friends and family). IUD use appears to be on the rise in the U.S., but many woman are still hesitant to consider this form of birth control due to a lack of understanding. IUD’s are not ideal for everyone, and when appropriate, I advise patients to look elsewhere for contraception. However, in many cases IUD’s are a reasonable and safe alternative to systemic hormonal options, such as oral contraceptive pills and the Depo-Provera shot.

Below is the basic information I share with my patients when they are considering an IUD. If knowledge is indeed power (and I believe it is), I hope that the following basics of IUD contraception empower you to select your best form of birth control.

~~~    ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~   ~~~

Screen shot 2013-02-25 at 6.13.24 PM

IUD’s are ideal for women seeking long-term, reversible birth control, and especially those in monogamous relationships with least exposure to STD’s.

There are 3 types of IUD’s available in the U.S.:
1. Paraguard — Copper, hormone-free, lasts approximately 10 years
2. Mirena — Localized progestin, lasts approximately 5 years
3. Skyla — Localized progestin, lasts approximately 3 years (recently FDA approved)

Paraguard is the better choice for hormone-sensitive women. However, it does increase bleeding and cramping and should not be the first choice for those with irregular, heavy, or painful cycles.

Mirena is the better choice for women with heavy, painful periods. The localized hormone decreases bleeding and calms the smooth muscle of the uterus. For some women, there may be minor systemic symptoms from the progestin, including nausea, breast tenderness and headaches.

Skyla is a recently FDA-approved IUD that (like the Mirena) supplies localized progestin, but in a smaller dose. Whereas the Mirena contains 52mg of Levonorgestrel at time of insertion, Skyla contains 13.5mg. Skyla may be a more appropriate choice for women with heavy, painful menses who are more hormone sensitive, and also for those hoping to conceive in the next five years.

For women hoping to conceive in the near-future:
1. I do not recommend an IUD unless you plan to wait at least 2 years before trying to conceive.
2. This recommendation is based on cost and inconvenience of discomfort. IUD’s cost between $500-$1,000 and the insertion process can be painful, as can removal. In some cases, the IUD will be expelled by the uterus and insertion must be repeated.

Some advantages to consider:
1. Compliance is automatic – no need to remember your pill or schedule an injection
2. IUD’s will not suppress your body’s hormonal system (though sensitive women may feel some symptoms of hormonal imbalance when using the Mirena)
3. Most woman can conceive immediately after removal
4. Decreased pain & bleeding with the Mirena

Some disadvantages to consider:
1. Discomfort during insertion (mild pelvic & back pain should resolve after the first few days)
2. Irregular menstrual cycles for up to 6 months
3. Increased pain & bleeding with the Paraguard
4. IUD’s do not protect against sexually transmitted diseases

Though an IUD does not increase risk of STD’s (a common misperception according to the study mentioned above), there are rare but significant health risks that every woman should understand before selecting this form of birth control:

PID – Pelvic Inflammatory Disease
IUD’s do not increase the risk of acquiring STD’s, but they do increase the risk of developing Pelvic Inflammatory Disease if you do become infected. PID is an infection of the uterus and fallopian tubes that lead to infertility and may even become life-threatening if untreated. I recommend an alternative form of birth control for women with a history of Pelvic Inflammatory Disease, or those at increased risk for STD’s such as Chlamydia. Remember, IUD’s do not protect against STD’s. Combine with a barrier device such as a condom to prevent spread of infection.
Expulsion

The uterus will sometimes partially or fully expel the IUD via smooth muscle contractions. This is most likely to happen shortly after insertion, but it can occur at any time, causing pain and bleeding. The old IUD must be removed and a new one inserted.
“Lost” IUD
Less commonly, an IUD will slip out of place within the uterus and day surgery may be required to remove the contraceptive. IUD position and need for surgical intervention can be assessed with pelvic ultrasound.
Ectopic Pregnancy
A very small percentage of women may become pregnant while using an IUD. For this group, there is an increased risk of ectopic pregnancy. Similar issues of pregnancy, miscarriage and increased risk for ectopic pregnancy are present with other forms of contraception, as well.

 

Remember, these are only the basics. Make an appointment with your healthcare provider to discuss your specific questions and needs.

 

Dr. Kaley Bourgeois

 

 

Sources:

Callegari, LisaS. “Perceptions of intrauterine contraception among women seeking primary care.” Contraception. (2012): n. page. Print. <http://www.contraceptionjournal.org/article/S0010-7824(13)00048-6/abstract>.

FAQ: Contraception.” . The American Congress of Obstetricians and Gynecologists, Web. 25 Feb 2013. <http://www.acog.org/~/media/For Patients/faq014.pdf?dmc=1&ts=20130225T1735419185>.

Sonfield, Adam. “Popularity Disparity: Attitudes About the IUD in Europe and the United States.” Guttmacher Policy Review. 10.4 (2007): n. page. Print. <http://www.guttmacher.org/pubs/gpr/10/4/gpr100419.html>.

Polycystic Ovarian What? 
Finally, a New Name on the Way

Polycystic Ovarian What? 
Finally, a New Name on the Way

Screen shot 2013-01-25 at 9.25.24 PM
I released a long-held sigh of relief today when I came across an announcement from the National Institutes of Health, declaring their decision to rename polycystic ovarian syndrome (PCOS). A minor thing to get worked up over? I think not. PCOS is a leading cause of infertility in young women, and a significant risk factor for type 2 diabetes, high cholesterol, and hypertension. Despite the name, PCOS often presents without any ovarian cysts. Why is this a concern? A misleading name will do exactly that: mislead.

As a naturopathic physician specializing in women’s health and endocrine disorders, I’ve had the opportunity to see how prevalent PCOS is, and how frequently it goes undiagnosed. Without ovarian pain, or confirmed ovarian cysts, a focused diagnostic work up for the hormonal disorder is often overlooked. Sometimes this is an oversight by the healthcare practitioner, but in many cases, it is related to patients not knowing when to seek care. Of the women I have diagnosed with PCOS, most have responded to my first mention of its name with something along the lines of “PCOS? Not me, I don’t have any cysts.” They’re half right.

What is PCOS?
Polycystic ovarian syndrome is a complex metabolic and hormonal disorder that involves both hyperandrogenism (elevated levels of androgen hormones, such as testosterone) and insulin resistance. Hormone and blood sugar imbalances effect the entire body, causing a wide variety of symptoms:

Irregular menstrual cycle, or complete loss of cycle
Infertility (Unable to conceive after 12+ months)
Excess hair growth on the face, back and chest
Thinning hair (scalp)
Oily skin
Weight gain, especially around the trunk
Acne
Ovarian cysts
Depression and anxiety

As you can see above, ovarian cysts are a very small piece of a very large puzzle. Their absence does not rule out a diagnosis of PCOS, nor does their presence guarantee one. In fact, single and even multiple ovarian cysts can exist women without any history of the condition.

With so many young women effected and at increased risk for life-altering diseases, early diagnosis and treatment of PCOS is invaluable. If you have irregular cycles in combination with any of the symptoms listed above, please do not hesitate to speak with your healthcare provider.

Are there natural treatment options?
There are many natural treatment options available to help balance your hormones, address insulin resistance and improve metabolic function. For my patients, I use a combination of dietary counseling, weight loss plans, bio-identical hormones, nutritional supplements and botanicals. Subclinical hypothyroidism is also present as well, and treatment with natural supplements or thyroid hormone replacement leads to significant improvement. Many women respond beautifully to these interventions, allowing them to avoid treatment through surgery, diabetes medications, birth control pills or anti-androgen medications.

Diet: Insulin resistance and elevated blood sugar are highly responsive to dietary modifications.
Weight Loss: Specific dietary changes, metabolic support and HCG Diet when appropriate.
Bio-Identical Hormones: Bio-identical progesterone in combination with aggressive treatment of insulin resistance (high insulin stimulates increased androgen production).
Nutritional Supplements: Specific to hormone metabolism, blood sugar balance and endocrine system support.
Botanicals: Specific to estrogen, testosterone and progesterone balance, as well as blood sugar metabolism.

 

Dr. Kaley Bourgeois

 

Reference:
“Panel recommends changing name of common disorder in women.” NIH News. National Institutes of Health, 23 Jan 2013. Web. 25 Jan 2013. <http://www.nih.gov/news/health/jan2013/od-23.htm>.

HPV At Any Age – Viral Infections & Reactivation in Women’s Health

With as many as 50% of young, sexually active women presenting with active Human Papilloma Virus (HPV), understanding the risk for cervical cancer due to persistent infection and the need for adequate screening is crucial. Cervical cancer can be prevented and mortality rates decreased so long as there is early detection and treatment.

It is well established that a higher number of lifetime sexual partners is associated with a greater risk for HPV infection, and therefore a greater risk for HPV-related lesions and cervical cancer. A recent study suggests that another factor, viral reactivation, may be involved in the increased risk for active HPV infection and cervical cancer later in life.

Though the rate of HPV infection in the USA tends to peak in the early 20’s and decline into older age, elsewhere in the world there is a secondary peak around menopause. The study, published in the Journal of Infectious Diseases in 2012, looked at HPV infection rates detected via routine screening in women 35-60 years of age. Of those infected, 77% had a lifetime history of 5 or more sexual partners, but nearly all of the participants reported zero new partners in the previous six months. This does not rule out new HPV exposure as the cause of infection, but it does suggest the possibility that active infections later in life may be due to reactivation of an earlier infection.

Other viruses are known to linger in the body at undetectable levels, only to resurface later and cause new illness. Two such viruses are varicella zoster and Epstein-Barr virus. Varicella zoster, the source of Chickenpox in childhood, can give rise to Shingles later in life. Epstein-Barr can repeatedly recur as Chronic EBV Infection and is even linked to certain cancers.

Might HPV also be lingering and reactivating? It is possible, and warrants further investigation. The current belief is that most young women’s bodies clear themselves of the virus within two years of infection. However, this is based on relatively short term studies that do not look beyond one or two negative screenings. Moreover, there are additional studies which show detection of type-specific HPV after many years of non-detection. It is not yet known whether this is due to re-infection or reactivation, but both must be considered.

Why are these new findings significant? Although HPV infection rates tend to decline with age in the USA, the secondary peak seen in some countries suggests that later infection (or reactivation) poses a very real health risk to middle-aged women world-wide. If the virus is reactivating, American women of the same age group are not immune, regardless of statistical averages. As with varicella zoster and EBV, the health of the individual plays a significant role in whether or not a virus can reactivate. For women with a history of HPV infection, and especially those with signs or symptoms of impaired immune system function, risk of HPV reactivation should be considered and discussed with a healthcare provider.

Below are the 2012 recommendations for HPV and cervical cancer screening, via the US Preventative Services Task Force (USPSTF):

 

Age/Other Factors                                       Recommendation

<21 years old                                                  No screening

21-29 years old                                              Screening pap smear every 3 years

30-65 years old, option 1                            Screening pap smear every 3 years*

30-65 years old, option 2                            Screening pap smear + HPV test every 5 years

>65 years old                                                 No screening if adequately screened before 65

Full hysterectomy                                        No screening unless there is a history of CIN2+

 

*At least one HPV test after 30 years old is advisable

Dr. Kaley Bourgeois

 

References:
Gravitt, Patti E., et al. “A Cohort Effect of the Sexual Revolution May Be Masking an Increase in Human Papillomavirus Detection at Menopause in the United States.” J Infect Dis.. 10.1093 (2012).
Infectious Diseases Society of America. “HPV in older women may be due to reactivation of virus, not new infection.” ScienceDaily, 13 Dec. 2012. Web. 19 Jan. 2013.
The American Congress of Obstetricians and Gynecologists. “New Cervical Cancer Screening Recommendations from the U.S. Preventive Services Task Force and the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology.” 14 Mar. 2012. Web. 19 Jan. 2013.

 

 

Progesterone Deficiency: Infertility, Irregular Cycles and More

Progesterone Deficiency: Infertility, Irregular Cycles and More

Fertility pic

Low progesterone production is a significant and frequent finding in the realm of women’s healthcare. It is no wonder that the term estrogen dominance can be found throughout magazines, health blogs and other sources of medical media. While estrogen dominance does exist, the label is often over-used and does not differentiate between the unique forms of hormone imbalance facing women of all ages.

Names and labels aside, low progesterone is at the root cause of various symptoms, including infertility, irregular cycles, painful & heavy periods, breast pain, premenstrual syndrome, poor sleep, and more. In addition to its direct roles in menstruation and pregnancy, progesterone is involved in multiple physiological processes such as water balance, and nervous system function. At healthy levels, it prevents excess water retention, and helps to calm the nervous system through its effect on neurotransmitters in the brain. For these reasons, low progesterone can cause pre-menstrual symptoms like bloating and weight gain, mood changes and poor sleep.

Lets discuss a few of the common health complaints linked to progesterone deficiency:

Infertility
Progesterone has the unique job of sustaining a healthy uterine lining for the two weeks following ovulation. This short window is necessary for conception. Furthermore, the ovaries must produce enough progesterone to support pregnancy for the first 10 weeks, until the placenta takes over.
The term luteal phase defect refers to a period of less than 10 days between ovulation and the 1st day of bleeding. Many women suffer from this symptom of progesterone deficiency without knowing it, even if they have a seemingly normal, 28 day cycle. Every women struggling with infertility should consider progesterone deficiency as a potential causes; your healthcare practitioner can help your to properly track your cycle, and order blood tests when needed.

Irregular Cycles
Progesterone deficiency often plays a role in menstrual cycles that are irregular. If your cycle does not occur on a monthly basis, or the time between your menstruation changes, you likely have an imbalance between progesterone and estrogen. This imbalance may be relative (meaning your progesterone is within normal range, but your estrogen levels are high), or purely due to low production of the hormone.

Uterine Fibroids & Endometriosis
Estrogen plays the role of stimulating tissue growth in the uterus to prepare for ovulation and pregnancy. Progesterone is responsible for balancing this and other effects of estrogen so that the tissue does not grow in excess.
When this balance fails, patients may develop signs of excess estrogen stimulation, including endometrial hyperplasia (overgrowth of uterine lining) and fibroids (benign tumors of the uterus). Insufficient progesterone is also suspected to play a role in endometriosis, a painful condition in which uterine tissue grows outside of the uterus. Though fibroids and endometrial hyperplasia are more common in middle-aged women heading toward menopause, all three may occur in young women and play a role in infertility.

 

Thankfully, low progesterone and associated hormone imbalances can often be corrected via botanical therapies, physiological hormone replacement, or both. When properly dosed, studies show that Vitex agnus-castus can significantly increase progesterone production. Likewise, there are hormone precursors that can be safely supplemented by your healthcare practitioner to support your body’s hormone production. When indicated, physiological doses of bio-identical progesterone can also reverse the symptoms of progesterone deficiency.

 

Dr. Kaley Bourgeois

 

References:
Natural Medicines Comprehensive Database. Updated Jan 4, 2013.
http://naturaldatabase.therapeuticresearch.com/

Estrogen-Only Therapy May Reduce Breast Cancer Risk

Our take:

“This article confirms 2 things we’ve been aware of for a long time:

Estrogen, a natural hormone is safe to use in sensible amounts – yes Estrogen/estradiol is a proliferative agent, but is also a differentiating agent that tells the cells to mature to a steady stable state and not grow out of control the way cancer does.

Progestins are toxic – so much so that this is the drug used in hormonal contraceptives and PlanB emergency contraceptives. Progesterone, is short for pro-gestational-hormone, is a natural hormone that balances estrogen out physiologically and also makes BHRT much safer. It is the Progestins that cause cancer.”

 

Estrogen-Only Therapy May Reduce Breast Cancer Risk

Some women who take estrogen-only hormone replacement therapy to stave off hot flashes, night sweats and other symptoms of menopause may be at lower risk for developing breast cancer down the road, a news study says.

Hormone replacement therapy (HRT) fell from grace rather dramatically after a large government-run trial, the U.S. Women’s Health Initiative, was stopped early in 2002 because HRT was shown to increase the risk of strokes and breast and ovarian cancer. Since that time, however, some subtleties have emerged as researchers parsed the evidence further. For example, short-term use of HRT is now deemed fairly safe for some women who have severe menopausal symptoms.

The new study shows that longer-term use of estrogen-only therapy may actually lower a woman’s odds of developing breast cancer. Estrogen-only therapy is reserved for women who have had a hysterectomy; women with an intact uterus who use HRT must take the hormone progestin with estrogen to prevent uterine cancer.

“Women who have had a hysterectomy may be reassured that taking estrogen by itself, short term, to relieve menopausal symptoms will not increase their risk of breast cancer,” said study author Garnet Anderson of the Women’s Health Initiative Clinical Coordinating Center at the Fred Hutchinson Cancer Research Center in Seattle. Women should not take estrogen to prevent breast cancer, she stressed.

The new findings were published in the March 7 online edition of The Lancet Oncology.

The North American Menopause Society recently released a position statement that backs up these findings. The group said starting combination hormone therapy (both estrogen and progestin) around the time of menopause to treat symptoms and stave off the brittle-bone disease osteoporosis is safe for some women for three to five years. Estrogen alone can be used for longer than the combination HRT, according to the society.

The new study, which was partially funded by drug manufacturer Wyeth, included more than 7,500 women from the Women’s Health Initiative who took estrogen for about six years. Roughly five years after stopping treatment, the women were 23 percent less likely to develop breast cancer when compared to their counterparts who never used HRT.

Women in the estrogen group who did develop breast cancer were 63 percent less likely to die from the disease, compared to women who never took it. The lower risk of breast cancer was seen only among women without risk factors for breast cancer, such as a history of benign breast disease or a strong family history of breast cancer, the study showed.

“The story is pretty clear about estrogen plus progestin — no matter the age of the women, estrogen plus progestin increases [the risk of] breast cancer, heart disease, stroke and blood clots,” Anderson said. “These risks outweigh the benefits for all age groups.”

Why estrogen alone may lower breast cancer risk while adding progestin seems to increase the risk is the million dollar question.

“There are hypotheses about the role of estrogen in breasts after a woman has gone through menopause,” Anderson said. For example, “her breast tissue, including any precancerous cells, may go through changes as a result of menopause that make them susceptible to estrogen in a way that discourages cell growth.”

Estrogen-only therapy is not without risks, however. For estrogen alone, the Women’s Health Initiative data showed no overall effect of estrogen on heart disease, but an increased risk of strokes and blood clots.

Women are understandably confused about whether they should take hormones to treat their menopausal symptoms, and for how long they can safely use the therapy.

“The best use of estrogen-alone is in women with a hysterectomy who need relief of hot flashes and night sweats and related menopausal symptoms,” Anderson said. These benefits need to be weighed against a woman’s risk of stroke or developing blood clots.

Dr. Lila Nachtigall, a professor of obstetrics and gynecology at NYU Langone Medical Center in New York City, agreed that, when used on its own, estrogen can still be safe and effective in treating the symptoms of menopause in women who do not have a uterus.

“It looks very definite that the bad guy is progestin, not estrogen,” Nachtigall said. Her advice is to use the lowest effective dose for the shortest amount of time. If more women took estrogen, she said, there would be a dent made in the epidemic of osteoporosis. “Millions of women who never went on estrogen, even for a few years, are really losing bone,” she said.

That said, estrogen does increase the risk of blood clots. “Women with blood-clotting disorders should not take it,” Nachtigall said.

Commenting on the study, Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said, “If you are looking to reduce menopausal symptoms and don’t have an intact uterus, [estrogen] is an option.” But estrogen-only therapy should not be prescribed indiscriminately, she added.

“This applies only to women who have severe menopausal symptoms. We are not saying that we should give women estrogen to reduce the risk of breast cancer,” Bernik added.

SOURCES:
Lila Nachtigall, M.D., professor, obstetrics and gynecology, NYU Langone Medical Center, New York City; Garnet Anderson, Ph.D., principal investigator, Women’s Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle; Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; March 7, 2012, The Lancet Oncology, online